SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
1. Name and Address of Reporting Person*
Barlas Irini

(Last) (First) (Middle)
C/O HERITAGE INSURANCE HOLDINGS, INC.
1401 N. WESTSHORE BLVD

(Street)
TAMPA FL 33759

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Heritage Insurance Holdings, Inc. [ HRTG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/01/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
01/21/2022
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/01/2022 A 2,721(1) A $0.00 38,771(2) I See Footnote(3)
Common Stock 06/23/2022 A 12,422(1) A $0.00 51,193(2) I See Footnote(3)
Common Stock 06/19/2023 A 9,662(1) A $0.00 60,855(2) I See Footnote(3)
Common Stock 12,746(2) D
Common Stock 6,852(2) I See Footnote(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. These shares were issued as a restricted stock grant to the Reporting Person by the Issuer. The restricted stock shall vest on the earlier of (i) the one-year anniversary of the grant date and (ii) the day immediately prior to the date of the following year's annual meeting of the stockholders of the Issuer.
2. This amendment is being filed to correct the reported form of ownership of the restricted stock granted to the Reporting Person by clarifying that such restricted stock is held indirectly rather than directly. This amendment amends the transactions reported on the following Form 4s: a January 1, 2022 transaction reported on a Form 4 filed on January 21, 2022; a June 23, 2022 transaction reported on a Form 4 filed on June 27, 2022; and a June 19, 2023 transaction reported on a Form 4 filed on June 21, 2023 as amended by Form 4/A filed on August 11, 2023.
3. Shares of common stock reported on this line are held by the Lee M. Barlas and Irini Barlas Living Trust.
4. Shares of common stock reported on this line are held by Ms. Barlas' spouse.
/s/ Irini Barlas 04/10/2024
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.